Conservative Treatment With Plasma Rich in Growth Factors-Endoret for Osteoradionecrosis
Conservative Treatment With Plasma Rich in Growth Factors-Endoret for Osteoradionecrosis
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DOI：
10.1097/scs.0000000000001537
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发表时间：
2015-05-01
影响因子：
0.9
通讯作者：
Mozzati, Marco
中科院分区：
文献类型：
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作者：
Gallesio, Giorgia;Del Fabbro, Massimo;Mozzati, Marco
目的：放射性骨坏死 (ORN) 是头颈部放疗引起的最严重的长期并发症，定义为暴露的坏死口腔骨区域，且至少 3 个月无法愈合。在大多数情况下，ORN 与涉及颌骨的口腔手术相关。本研究的目的是评估生物方法治疗 ORN 的安全性和有效性。方法：使用超声装置清创坏死骨，然后应用富含生长因子 (PGRF) 的血浆 - Endoret 来治疗 10 名 ORN 患者，以改善和加速软组织愈合。对患者进行长达 12 个月的临床和放射学随访。术后第一周使用视觉模拟评分（VAS）评估疼痛。使用改良的愈合指数评估组织愈合的成熟度和质量。结果：所有病例均成功治疗。无术中或术后并发症发生。临床和放射学评估显示在长达 12 个月的随访中没有持续感染或暴露骨骼的迹象。再生组织的成熟度和质量非常好，手术伤口总是能完全闭合。所有患者的 VAS 评分和牙关紧闭都很低，术后第三天起就没有服用镇痛药。 结论：PRGF-Endoret 作为放射性骨坏死手术治疗的辅助手段，对于有头颈部放疗史的患者可预测地增强组织血管化和上皮化。
Objectives: Osteoradionecrosis (ORN) is the worst long-term complication due to radiotherapy to the head and neck and is defined as an area of exposed necrotic oral bone, with failure to heal for at least 3 months. In most cases, ORN is associated with oral surgery procedures involving the jaw bone. The aim of this study was to evaluate the safety and effectiveness of a biological approach for ORN treatment.Methods: A series of 10 patients with ORN were treated by debridement of necrotic bone using an ultrasound device followed by application of plasma rich in growth factors (PGRF)-Endoret to improve and accelerate soft-tissue healing. Patients were followed clinically and radiographically up to 12 months. Pain was assessed in the first week postsurgery using a visual analogue scale (VAS). Maturation and quality of tissue healing was assessed using a modified healing index.Results: All cases were successfully treated. No intraoperative or postoperative complications occurred. Clinical and radiographic evaluations showed no signs of persistent infection or exposed bone up to 12 months of follow-up. The maturity and quality of the regenerated tissues was excellent, surgical wounds always achieving complete closure. VAS scores and trismus were very low in all patients, which did not take analgesics since the third day after surgery.Conclusions: PRGF-Endoret is beneficial, as an adjunct to surgical treatment of osteoradionecrosis, for predictable enhancement of tissue vascularization and epithelialization in patients with a history of head and neck radiotherapy.